Wound closure device including direct-driven needle

ABSTRACT

A suturing device includes a housing, a rod, a ferrule assembly, and a needle. The housing defines a guide lumen extending longitudinally therethrough. The rod is engaged with the housing and extends distally therefrom. The ferrule assembly is disposed at a distal end of the rod and is configured to releasably retain a ferrule therein. The ferrule is adapted to retain of a portion of a suture therein. The needle is configured for translation through the guide lumen defined within the housing. A distal end of the needle is configured to engage the ferrule within the ferrule assembly for removal of the ferrule from the ferrule assembly.

CROSS-REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.15/176,193, filed Jun. 8, 2016, which is a continuation of U.S. patentapplication Ser. No. 14/069,108, filed Oct. 31, 2013, now U.S. Pat. No.9,386,980, which is a division of U.S. patent application Ser. No.12/887,902, filed Sep. 22, 2010, now U.S. Pat. No. 8,591,529, whichclaims the benefit of U.S. Provisional Application Ser. No. 61/247,644,filed Oct. 1, 2009, the disclosures of each of the above-identifiedapplications being hereby incorporated by reference in their entirety.

TECHNICAL FIELD

The present disclosure relates to a wound closure device and, moreparticularly, to a wound closure device having a direct driven needlefor suturing a wound.

BACKGROUND

Puncture wounds, wounds that pierce through tissue, may result fromtrauma or may be intentionally created in order to provide access to abody cavity during surgical procedures. During endoscopic surgicalprocedures, for example, a trocar device is utilized to puncture theperitoneum to provide an access port by way of a cannula through theabdominal wall. Generally, a trocar and/or cannula is placed through theabdominal wall for introduction of surgical instrumentation which isnecessary to carry out the surgical procedure. In this manner, thesurgeon may introduce a surgical instrument such as a grasper, scissor,clip applier, stapler or any other surgical instrument which may benecessary during the particular surgical procedure. Once the procedureis complete, it is necessary to suture the wound.

Conventional instruments for closing puncture wounds generally include ashaft that can be extended into the body through either the puncturewound itself (in the case of a puncture caused by trauma) or through acannula (in the case of a puncture created to access a surgical site).Suture retaining needles are then deployed from the shaft into tissue.Unfortunately, the mechanisms used for deploying the needles are oftencumbersome and may make the extension and/or retraction of the suturingdevice difficult.

In the prior art, U.S. Pat. No. 5,470,338 discloses a suturinginstrument for closing trocar puncture wounds. The suturing instrumentincludes a pair of needle carriers having needles releasably retainedthereon. The needle carriers are translatable from a retracted positionto a deployed position via a rack and pinion mechanism to urge theneedles into tissue. U.S. Pat. No. 7,235,087 discloses an articulatingsuturing device including a shaft having an articulated foot disposed ata distal end thereof. The foot includes suture attachment cuffs thatlockingly engage needles such that the cuffs can be withdrawn uponwithdrawal of the needles. U.S. Pat. No. 7,449,024 discloses a suturingdevice having at least two arms that are extendable from the shaft ofthe suturing device. The arms are rotated about a pivot to extend fromthe shaft. Needles may then be inserted into engagement with the arms toretrieve a suture from the arms. U.S. Patent Application Publication No.2006/0030868 discloses a suturing device including a pair of wings thatare selectively extendable from the device. Needles carrying suturesthereon may then be advanced through tissue and into engagement with thewings to retain the sutures thereon. U.S. Patent Application PublicationNo. 2006/0069397 discloses a suturing apparatus similar to that of U.S.Pat. No. 7,449,024, discussed above, and further discloses a handleassembly for actuating the suturing apparatus. U.S. Patent ApplicationPublication No. 2008/0045979 discloses an articulating suturing devicesimilar to that of U.S. Pat. No. 7,235,087, discussed above.

SUMMARY

In accordance with one embodiment of the present disclosure, a suturingdevice is provided. The suturing device includes a housing defining aguide lumen extending longitudinally therethrough. A rod is engaged withthe housing and extends distally therefrom. A ferrule assembly isdisposed at a distal end of the rod. The ferrule assembly is configuredto releasable retain a ferrule therein. The ferrule is adapted to retainof a portion of a suture therein. A needle is configured for translationthrough the guide lumen defined within the housing. A distal end of theneedle is configured to engage the ferrule within the ferrule assemblyfor removal of the ferrule from the ferrule assembly.

In one embodiment, the ferrule assembly includes a curved portion and aferrule holder. One end of the curved portion is attached to the distalend of the rod. The other end of the curved portion retains the ferruleholder thereon. The ferrule is disposed within a lumen defined throughthe ferrule holder.

In another embodiment, the ferrule assembly and/or the housing includesa tissue stop positionable about a face of tissue upon insertion of thesuturing device into a wound in tissue. The tissue stop of the ferruleassembly may be configured to engage the rod and to releasable retainthe ferrule therein.

In yet another embodiment, the needle and the ferrule are configured toengage each other in a male-female friction fit engagement.

In still another embodiment, the rod is selectively securable within thehousing along a length of the rod. The rod is securable within thehousing between a first position in which the rod extends a minimumdistance distally from the housing and a second position in which therod extends a maximum distance distally from the housing.

In still yet another embodiment, the ferrule assembly includes one ormore compliance features configured to reduce the likelihood of damagingthe suturing instrument and/or surrounding tissue.

A method of suturing a wound is also provided in accordance with thepresent disclosure. The method includes providing a suturing deviceaccording to any of the above embodiments. The method further includesinserting the suturing device through a wound such that the ferruleassembly is disposed on an interior surface of tissue to be sutured,inserting the needle into the guide lumen and through tissue to engagethe ferrule, translating the needle proximally to remove the ferrulefrom the ferrule assembly, and translating the needle proximally backthrough tissue, thereby passing the ferrule and the portion of sutureattached thereto through tissue.

In one embodiment, the method further includes removing the suturingdevice from the wound. The suturing device may then be re-loaded and theabove-described method may be repeated on an opposite side of the wound.Finally, the sutures disposed through tissue on opposite sides of thewound may be tied off to close the wound.

In yet another embodiment, prior to inserting the suturing devicethrough a wound, the positioning of the rod with respect to the housingmay be adjusted according to a thickness of tissue to be sutured.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the subject suturing device are described hereinwith reference to the drawings wherein:

FIG. 1 is a side view of a suturing device according to one embodimentof the present disclosure;

FIG. 2 is a side, cross-sectional view of the suturing device of FIG. 1;

FIG. 3 is an enlarged, cross-sectional view of a ferrule assembly of thesuturing device of FIG. 2;

FIG. 4 is a side view of a suturing device according to anotherembodiment of the present disclosure;

FIG. 5 is a side, cross-sectional view of the suturing device of FIG. 4;

FIG. 6 is an enlarged, cross-sectional view of a ferrule assembly of thesuturing device of FIG. 5;

FIG. 7 is a side view of a suturing device according to yet anotherembodiment of the present disclosure;

FIG. 8 is a side, cross-sectional view of the suturing device of FIG. 7;and

FIG. 9 is an enlarged, cross-sectional view of a ferrule assembly of thesuturing device of FIG. 8.

DETAILED DESCRIPTION

In the figures and in the description that follows, in which likereference numerals identify similar or identical elements, the term“proximal” will refer to the end of the apparatus which is closest tothe operator during use, while the term “distal” will refer to the endwhich is farthest from the operator, as is traditional.

Turning now to FIGS. 1-3, a suturing device 100 is shown generallyincluding a housing 110, a rod 120, a ferrule assembly 140 and a needle170. Housing 110 includes a proximal portion 112 and an elongated distalportion 114. Proximal portion 112 includes finger ring 113 definedtherethrough to allow an operator to grasp the suturing device 100. Rod120 is disposed through lumen 116 of housing 110 and is fixedly engagedtherein, although, as will be described in embodiments below, rod 120may be selectively translatable with respect to housing 110 to forvarying the length of suturing device 100. Rod 120 extends distally fromproximal portion 112. A ferrule assembly 140 is disposed at a distal end122 of rod 120. Ferrule assembly 140 includes a curved, or U-shaped,portion 142, although other configurations, e.g., angled, arecontemplated. Curved portion 142 is attached at a first end 144 to thedistal end 122 of rod 120. A second end 146 of curved portion 142 isconfigured to retain ferrule holder 150 thereon. Ferrule holder 150includes a lumen 154 defined therein. Ferrule 160 is releasable retainedwithin lumen 154 of ferrule holder 150. A portion of a suture 190, e.g.,a suture loop 190, is disposed within lumen 154 of ferrule holder 150.Suture loop 190 is disposed through aperture 162 of ferrule 160 at afirst end 192 thereof and through aperture 156 of ferrule holder 150 atsecond end 194 thereof such that suture loop 190 interconnects, orcouples ferrule 160 and ferrule holder 150. Alternatively, suture loop190 may be secured to curved portion 142 of ferrule assembly 140, or maybe configured to extend proximally from ferrule holder 150, passingthrough a lumen (not shown) defined within housing 110.

Referring now to FIGS. 2-3, needle 170, which is disposed through lumen118 defined within housing 110, includes a distal tip 172 and isconfigured to translate through lumen 118 to engage ferrule 160. Needle170 is hollow, defining a lumen 174 therethrough. Once needle 170 isinserted through lumen 118 of housing 110, lumen 118 acts as a guide forneedle 170. Specifically, lumen 118 is of sufficiently large diameter toallow needle 170 to readily translate therethrough but is also ofsufficiently small diameter as to inhibit needle 170 from angling ortilting within lumen 118. Thus, once needle 170 is inserted into lumen118 and translated distally therethrough, lumen 118 directs, or guidesneedle 170 toward ferrule holder 150.

As can be appreciated, upon further distal translation of needle 170through lumen 118 of housing 110, distal tip 172 of needle 170eventually enters lumen 154 defined within ferrule holder 150. Asmentioned above, lumen 118 guides, or directs needle 170 toward ferruleholder 150, inhibit needle 170 from becoming mis-aligned with ferruleholder 150 as needle 170 is translated through tissue. As needle 170 isurged distally into lumen 154, needle 170 surrounds ferrule 160 i.e.,ferrule 160 enters lumen 174 of needle 170. Lumen 174 may have aslightly smaller diameter than ferrule 160 such that, when needle 170 isurged around ferrule 160, ferrule 160 becomes lodged within lumen 174,retaining ferrule 160 therein via a releasable male-female friction-fitengagement. Alternatively, lumen 174 may taper proximally from distaltip 172 from a first diameter which is larger than the diameter offerrule 160 to a second diameter which is smaller than the diameter offerrule 160. In this configuration, further urging of ferrule 160 intolumen 174 engages ferrule 160 within lumen 174 in a friction-fitengagement. In another alternative embodiment, needle 170 is of asufficiently small diameter to engage a lumen (not shown) defined inferrule 160. In this embodiment, needle 170 may be urged into the lumendefined in ferrule 160 such that the ferrule 160 and needle 170 areengaged in a male-female friction-fit engagement. It is envisioned thatany of the above-mentioned configurations of needle 170 and ferrule 160may be used in accordance with any of the embodiments discussed herein.

As mentioned above, and as shown in FIG. 3, suture 190 is attached toferrule holder 150 of ferrule assembly 140 (via aperture 156) at one end194 thereof and to ferrule 160 (via aperture 162) at the other end 192thereof. In preparation for use, with suture 190 engaged to both ferruleholder 150 and ferrule assembly 140, ferrule 160 is releasably retainedwithin lumen 154 of ferrule holder 150.

With reference again to FIGS. 1-3, the operation of suturing device 100will be described. Once suture 190 and ferrule 160 are loaded intoferrule holder 150, as described above, suturing device 100 is insertedinto a wound to be sutured. Suturing device 100 is translated distallythrough the wound such that ferrule assembly 140 is positioned adjacentan interior face of tissue and such that elongated distal portion 114 ofhousing 110 is positioned adjacent an external, or opposing, face oftissue. In other words, suturing device 100 is positioned such thattissue to be sutured is disposed between ferrule assembly 140 andelongated distal portion 114 of housing 110. It is envisioned that alength of rod 120 may be dimensioned according to the thickness or rangeof thicknesses of tissue to be suture such that the gap between ferruleassembly 140 and elongated distal portion 114 is sufficiently large asto allow tissue having a certain thickness to be disposed therebetween.Thus, for suturing relatively thin tissue, suturing device 100 may beconfigured such that rod 120 is relatively short in length. On the otherhand, if it is desired to suture relatively thick tissue, suturingdevice 100 may be configured such that rod 120 is relatively long inlength. Alternatively, as will be discussed in embodiments discussedbelow, rod 120 may be adjustable such that suturing device 100 may beused to suture tissues having a wide range of thicknesses.

With tissue to be sutured disposed between the ferrule assembly 140 andthe elongated distal portion 114 of housing 110, needle 170 may beinserted through lumen 118 defined within housing 110. In order tomaintain suturing device 100 in the position described above, anoperator may position a finger through finger ring 113 defined withinhousing 110. Needle 170 is translated distally through lumen 118 andtissue, guided toward ferrule holder 150 by lumen 118 defined withinhousing 110. While the operator holds suturing device 100 in position,needle 170 is translated further distally such that distal tip 172 ofneedle 170 passes completely through tissue to be sutured and enterslumen 154 of ferrule holder 150. Needle 170 is then urged further intoengagement with ferrule holder 150 to releasably engage ferrule 160thereon.

Once needle 170 is inserted into lumen 154 of ferrule holder 150 toengage ferrule 160 within lumen 174 of needle 170, needle 170 may bepulled proximally. As needle 170 is pulled proximally, ferrule 160 isremoved from ferrule holder 150. Needle 170 and, thus, ferrule 160 andfirst end 192 of suture 190, which are engaged thereto, are translatedproximally through tissue until needle 170 and ferrule 160 have passedcompletely through tissue, leaving suture 190 disposed through tissue,e.g., such that first end 192 of suture 190 is disposed on a proximalside of tissue, while second end 194 of suture 190 remains disposed on adistal side of tissue since second end 194 of suture 190 is disposedthrough aperture 156 of ferrule holder 150. Suturing device 100 may thenbe removed, reloaded with another ferrule holder 150 having a ferrule160 disposed thereon, and positioned on an opposite side of the wound.Ferrule 160 may then be removed from lumen 174 of needle 170 such thatthe above-described method can be repeated on an opposite side of thewound, or at various positions around the wound. Ultimately, theoperator may tie off the sutures 190 to suture the wound closed.

Referring now to FIGS. 4-6, another embodiment of the presentlydisclosed suturing device 200 is shown. In the embodiment of FIGS. 4-6,as in the previous embodiment, suturing device 200 includes a housing210, a ferrule assembly 240 and a needle 270. Housing 210 includes aproximal portion 212 and an elongated distal portion 214. Proximalportion 212 includes finger ring 213 defined therethrough. Finger ring213 is dimensioned to allow an operator to grasp the suturing device 200with a single hand. Rod 220 is disposed through a lumen 216 definedthrough housing 210. Rod 220 is selectively positionable within housing210 via latch 230. More particularly, when latch 230 is disposed in theclosed position, as shown in FIG. 4, rod 220 is fixedly secured withrespect to housing 210. When latch 230 is released to the open position,rod 220 is translatable through lumen 216 with respect to housing 210.Thus, as can be appreciated, rod 220 may be selectively positioned withrespect to housing 210 such that rod 220 extends distally from housing210 a desired distance. Latch 230 may be any suitable locking mechanismcapable of securing rod 220 in position when closed and allowing rod 220to translate through lumen 116 when open. As mentioned above, theability to selectively position rod 220 with respect to housing 210 isadvantageous in that the suturing device 200 may be used to suturetissues having a wide range of thicknesses. Alternatively, latch 230 maybe fixed closed such that, as in the embodiment of FIGS. 4-6, rod 220 isfixed with respect to housing 210.

With continued reference to FIGS. 4-6, ferrule assembly 240 is disposedat a distal end 222 of rod 220. As can be appreciated, depending on thepositioning of rod 220 with respect to housing 210, ferrule assembly 240is either closer to or farther from housing 210. Ferrule assembly 240includes first and second lumens 244 and 246, respectively, defined indiametrically opposed sides of ferrule assembly 240, although otherconfigurations are contemplated. Lumens 244 and 246 extend from aproximal surface 247 of ferrule assembly 240 partially, but notentirely, therethrough such that distal surface 248 of ferrule assembly240 defines a continuous surface. Distal surface 248 of ferrule assembly240 may be generally conically shaped to facilitate the insertion ofsuturing instrument 200 through an opening in tissue and/or may alsoinclude a blunt tip portion to help avoid damaging tissue upon insertioninto an opening in tissue. Proximal surface 247 of ferrule assembly 240may be configured as a tissue stop 247 such that, as will be discussedbelow, when needle 270 and ferrule 240 are pulled proximally, tissuestop 247 contacts an interior surface of tissue to be sutured, therebyhelping to inhibit proximal movement of suturing device 200.Additionally, distal surface 215 of elongated distal portion 214 ofhousing 210 may also be configured as a tissue stop 215 such that tissuestop 215 helps to inhibit distal translation of suturing device 200 oncetissue stop 215 contacts an exterior surface of tissue.

With continued reference to FIGS. 4-6, rod 220 is disposed through firstlumen 244 of ferrule assembly 240 and is fixedly secured thereto. Secondlumen 246 of ferrule assembly 240 is configured to releasably retainferrule 250 therein. Ferrule 250 may simply be retained within secondlumen 246 due to the confines of second lumen 246 or may be retainedtherein via any other suitable structures. A suture 290 is secured, ortied to ferrule 250 at the free ends 292 thereof. As best shown in FIG.6, suture 290 is disposed about ferrule assembly 240 and extendsproximally therefrom, passing through a lumen (not shown) defined withinhousing 210. Looped end 294 of suture 290 extends proximally fromhousing 210. Alternatively, suture 290 may be configured to engageferrule 250 and extend proximally though a lumen (not shown) definedwithin rod 220, ultimately extending proximally from housing 210.

The operation of suturing device 200 is similar to that of suturingdevice 100, discussed above. First, rod 220 is fixed in position withrespect to housing 210 via latch 230 according to the thickness oftissue to be sutured. As can be appreciated, rod 220 would be positionedto extend a relatively small distance from housing 210 where tissue tobe sutured has a relatively small thickness and would be positioned toextend a larger distance from housing 210 where tissue to be sutured isrelatively thick. Once latch 230 is closed, fixing rod 220 in position,suturing device 200 is inserted through a wound such that ferruleassembly 240 is disposed adjacent an interior face of tissue to besutured. If adjustments are needed, tissue stop 247 is moved proximallyusing rod 220 and latch 230 until tissue stop 247 abuts an inner surfaceof tissue with tissue stop 215 in contact with an exterior surface oftissue. The latch 230 is then locked, fixing the relative positions oftissue stops 215 and 247 to define a gap therebetween.

Next, needle 270 is inserted into guide lumen 218. Guide lumen 218directs needle 270 toward ferrule 250 upon distal translation of needle270 therethrough. Upon further distal translation of needle 270 throughtissue, distal tip 272 of needle 270 enters lumen 246 of ferruleassembly 240. Needle 270 is dimensioned such that needle 270 maytranslated at least partially through lumen 246 of ferrule assembly 240.Needle 270 may also define a lumen 274 therethrough, such that as needle270 is translated through lumen 274, ferrule 250 is accepted throughlumen 274 of needle 270. Ferrule 250 and lumen 274 of needle 270 aredimensioned to have a substantially similar diameter such that, asneedle 270 is urged into lumen 246 of ferrule assembly 240, ferrule 250is lodged within lumen 274 of needle 270 via a friction-fit male-femaleengagement.

Once ferrule 250 is lodged within needle 270, needle 270 may betranslated proximally back through tissue, translating ferrule 250through tissue as well. If suturing device 200 begins to translateproximally along with needle 270, tissue stop 247 of ferrule assembly240 will eventually contact an interior surface of tissue to inhibitsuturing device 200 from moving proximally, thereby allowing only needle270 to move with respect to suturing device 200. Translating needle 270and ferrule 250 further proximally and completely out of tissue leavessuture 290 disposed through tissue. More particularly, free end 292 ofsuture 290 are positioned on a proximal side of tissue, with suture 290extending through tissue, exiting tissue on a distal side thereof andextending proximally through the wound in tissue to looped end 294thereof. The positioning, or configuration of suture 290, when disposedthrough tissue, facilitates the tying off of suture (or sutures) 290. Assuch, a similar procedure as described above may be completed on anopposite side (or sides) of the wound and the sutures 290 may then betightened and tied off to close the wound.

Referring now to FIGS. 7-9, another embodiment of a suturing device 300includes a housing 310, a ferrule assembly 340 and a needle 370. Housing310 includes a proximal portion 312 and an elongated distal portion 314.Proximal portion 312 includes finger ring 313 defined therethrough,while distal portion 314 includes a latch 330 disposed thereon. Rod 320is disposed through a lumen 316 defined through housing 310. Housing 310is configured substantially similarly to housing 210 described above andthus the description thereof will not be repeated here.

With continued reference to FIGS. 7-9, ferrule assembly 340 is shownincluding base portion 344 and tissue stop 346. Ferrule assembly 340further includes a first lumen 345 defined within the base portion 344for fixedly securing rod 320 therethrough and a second lumen 347 definedwithin tissue stop 346 for releasably retaining ferrule 350 therein.Free end 392 of suture 390 is attached to ferrule 350, while looped end394 of suture 390 extends around base portion 344 and proximallytherefrom, ultimately extending through a lumen (not shown) definedwithin housing 310. Alternatively, suture 390 may be configuredaccording to any of the embodiments above. Base portion 344 may beconfigured in any shape (e.g., conical) to facilitate the positioning ofsuturing instrument 300 through an opening in tissue. Additionally, baseportion 344 may be configured to protect tissue stop 346 and ferrule 350during insertion of suturing instrument 300 into tissue.

As best shown in FIG. 9, base portion 344 and tissue stop 346 are atleast partially separated by a compliance feature 348, e.g., a slot 348defined within ferrule assembly 340. Base portion 344 may furtherinclude an aperture 349 defined therethrough. Slot 348 and/or aperture349 may be configured to provide some degree of compliance, orflexibility to ferrule assembly 340 to protect against damaging suturingdevice 300 and surrounding tissue and to facilitate the operation ofsuturing device, e.g., during insertion of suturing device 300 intotissue, insertion of needle 370 into ferrule assembly 340, engagement ofneedle 370 and ferrule 360, removal of needle 370 and ferrule 360 fromferrule assembly 340, or other similar actions wherein a force isapplied to ferrule assembly 340 and/or tissue.

In operation, similar to the embodiments discussed above, needle 370 isinserted through guide lumen 318 of housing 310 and through tissue.Needle 370 is configured to translate at least partially through lumen347 of tissue stop 346, thereby engaging ferrule 350 thereon, e.g. via amale-female friction fit engagement or a female-male friction fitengagement. Thereafter, needle 370 may be translated proximally, pullingferrule 350 and suture 390 through tissue. The above-mentioned proceduremay then be repeated as desired on opposing sides of the wound. Thesutures 390 may then be tied off to close the wound.

From the foregoing and with reference to the various figure drawings,those skilled in the art will appreciate that certain modifications canalso be made to the present disclosure without departing from the scopeof the same. While several embodiments of the disclosure have been shownin the drawings, it is not intended that the disclosure be limitedthereto, as it is intended that the disclosure be as broad in scope asthe art will allow and that the specification be read likewise.Therefore, the above description should not be construed as limiting,but merely as exemplifications of particular embodiments. Those skilledin the art will envision other modifications within the scope and spiritof the claims appended hereto.

What is claimed is:
 1. A method of suturing an opening in tissue, comprising: inserting a suturing device through an opening in tissue, the suturing device including a housing defining a guide lumen, a rod coupled to the housing and extending distally from the housing, and a ferrule assembly coupled to a distal portion of the rod, the ferrule assembly releasably engaging a first ferrule, the first ferrule retaining a portion of a first suture, wherein the suturing device is inserted through the opening in tissue such that the ferrule assembly is disposed on an interior side of tissue; inserting a needle distally through the guide lumen defined within the housing, through tissue, and at least partially into the ferrule assembly to engage the first ferrule with a distal end portion of the needle; and translating the needle proximally to disengage the first ferrule from the ferrule assembly and move the needle proximally through tissue and the guide lumen defined within the housing to withdraw the first ferrule and the portion of the first suture from the guide lumen.
 2. The method according to claim 1, further including removing the suturing device from the opening in tissue.
 3. The method according to claim 2, further including re-loading the suturing device by releasably engaging a second ferrule with the ferrule assembly, the second ferrule retaining a portion of a second suture.
 4. The method according to claim 3, further including disengaging the first ferrule from the distal end portion of the needle.
 5. The method according to claim 4, further including: inserting the suturing device through the opening in tissue such that the ferrule assembly is disposed on the interior side of tissue on an opposite side of the opening in tissue; inserting the needle distally through the guide lumen defined within the housing, through tissue, and at least partially into the ferrule assembly to engage the second ferrule with the distal end portion of the needle; and translating the needle proximally to disengage the second ferrule from the ferrule assembly and move the needle proximally through tissue and the guide lumen defined within the housing to withdraw the second ferrule and the portion of the second suture from the guide lumen.
 6. The method according to claim 5, further including removing the suturing device from the opening in tissue.
 7. The method according to claim 6, further including tying off the first and second sutures to close the opening in tissue.
 8. The method according to claim 1, further including adjusting the positioning of the rod with respect to the housing according to a thickness of tissue to be sutured before inserting the needle.
 9. The method according to claim 8, wherein the position of the rod with respect to the housing is adjusted before inserting the suturing device.
 10. The method according to claim 1, wherein the suturing device is inserted such that tissue is disposed between a distal end portion of the guide lumen and the ferrule assembly. 